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Comparison of a nasal glucocorticoid, antileukotriene, and a combination of antileukotriene and antihistamine in the treatment of seasonal allergic rhinitis.
J Allergy Clin Immunol 2002; 109(6):949-55JA

Abstract

BACKGROUND

Allergic rhinitis requires active intervention for symptom relief. A combination of antileukotriene and antihistamine drugs has been suggested to provide additive treatment benefits for patients with allergic rhinitis.

OBJECTIVE

We evaluated how such a combination treatment would affect symptoms and local mucosal eosinophilia in comparison with a nasal glucocorticoid.

METHODS

In a double-blind, randomized study 62 patients with grass pollen-induced allergic rhinitis received a nasal glucocorticoid (fluticasone propionate aqueous nasal spray [FPANS], 200 microg/d), an antileukotriene (montelukast, 10 mg/d), a combination of montelukast with an antihistamine (loratadine, 10 mg/d), or placebo throughout the season. Cromoglycate eyedrops and a limited amount of loratadine were allowed as rescue medication for severe symptoms. Patients recorded their symptoms for nasal blockage, itching, rhinorrhea, and sneezing. Before and during the season, nasal biopsy specimens were obtained from patients for evaluation of local eosinophilic inflammation.

RESULTS

During the peak season, both FPANS and combined montelukast-loratadine were significantly more effective than placebo and montelukast alone for daytime symptom prevention. For nighttime symptoms, FPANS was significantly more effective compared with all other treatments, whereas combined montelukast-loratadine and montelukast alone did not provide significant symptom prevention compared with placebo. The pollen-induced increase in the numbers of epithelial eosinophils was significantly lower for FPANS-treated patients compared with that seen in all other treatment groups.

CONCLUSION

In patients with seasonal allergic rhinitis, intranasal glucocorticoids are more effective than an antileukotriene drug or combined antileukotriene-antihistamine for the reduction of pollen-induced nasal eosinophilic inflammation and for control of nasal symptoms.

Authors+Show Affiliations

Lung Pharmacology Group, Department of Respiratory Medicine and Allergology, Institute of Internal Medicine, Göteborg University, Gothenburg, Sweden.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12063523

Citation

Pullerits, Teet, et al. "Comparison of a Nasal Glucocorticoid, Antileukotriene, and a Combination of Antileukotriene and Antihistamine in the Treatment of Seasonal Allergic Rhinitis." The Journal of Allergy and Clinical Immunology, vol. 109, no. 6, 2002, pp. 949-55.
Pullerits T, Praks L, Ristioja V, et al. Comparison of a nasal glucocorticoid, antileukotriene, and a combination of antileukotriene and antihistamine in the treatment of seasonal allergic rhinitis. J Allergy Clin Immunol. 2002;109(6):949-55.
Pullerits, T., Praks, L., Ristioja, V., & Lötvall, J. (2002). Comparison of a nasal glucocorticoid, antileukotriene, and a combination of antileukotriene and antihistamine in the treatment of seasonal allergic rhinitis. The Journal of Allergy and Clinical Immunology, 109(6), pp. 949-55.
Pullerits T, et al. Comparison of a Nasal Glucocorticoid, Antileukotriene, and a Combination of Antileukotriene and Antihistamine in the Treatment of Seasonal Allergic Rhinitis. J Allergy Clin Immunol. 2002;109(6):949-55. PubMed PMID: 12063523.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of a nasal glucocorticoid, antileukotriene, and a combination of antileukotriene and antihistamine in the treatment of seasonal allergic rhinitis. AU - Pullerits,Teet, AU - Praks,Lea, AU - Ristioja,Vahur, AU - Lötvall,Jan, PY - 2002/6/14/pubmed PY - 2002/7/31/medline PY - 2002/6/14/entrez SP - 949 EP - 55 JF - The Journal of allergy and clinical immunology JO - J. Allergy Clin. Immunol. VL - 109 IS - 6 N2 - BACKGROUND: Allergic rhinitis requires active intervention for symptom relief. A combination of antileukotriene and antihistamine drugs has been suggested to provide additive treatment benefits for patients with allergic rhinitis. OBJECTIVE: We evaluated how such a combination treatment would affect symptoms and local mucosal eosinophilia in comparison with a nasal glucocorticoid. METHODS: In a double-blind, randomized study 62 patients with grass pollen-induced allergic rhinitis received a nasal glucocorticoid (fluticasone propionate aqueous nasal spray [FPANS], 200 microg/d), an antileukotriene (montelukast, 10 mg/d), a combination of montelukast with an antihistamine (loratadine, 10 mg/d), or placebo throughout the season. Cromoglycate eyedrops and a limited amount of loratadine were allowed as rescue medication for severe symptoms. Patients recorded their symptoms for nasal blockage, itching, rhinorrhea, and sneezing. Before and during the season, nasal biopsy specimens were obtained from patients for evaluation of local eosinophilic inflammation. RESULTS: During the peak season, both FPANS and combined montelukast-loratadine were significantly more effective than placebo and montelukast alone for daytime symptom prevention. For nighttime symptoms, FPANS was significantly more effective compared with all other treatments, whereas combined montelukast-loratadine and montelukast alone did not provide significant symptom prevention compared with placebo. The pollen-induced increase in the numbers of epithelial eosinophils was significantly lower for FPANS-treated patients compared with that seen in all other treatment groups. CONCLUSION: In patients with seasonal allergic rhinitis, intranasal glucocorticoids are more effective than an antileukotriene drug or combined antileukotriene-antihistamine for the reduction of pollen-induced nasal eosinophilic inflammation and for control of nasal symptoms. SN - 0091-6749 UR - https://www.unboundmedicine.com/medline/citation/12063523/Comparison_of_a_nasal_glucocorticoid_antileukotriene_and_a_combination_of_antileukotriene_and_antihistamine_in_the_treatment_of_seasonal_allergic_rhinitis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091674902000088 DB - PRIME DP - Unbound Medicine ER -